tailieunhanh - Disorders Techniques in Investigation and Diagnosis - part 8

Điều trị thay đổi sừng Khi thay đổi sừng xung quanh móng tay cho đến các triệu chứng, điều trị ngay lập tức liên quan đến việc cắt bỏ bảo thủ của các tấm móng tay để phơi bày những tổn thương. Tăng sừng sau đó có thể được debrided dao mổ. Sulcal chai cứng đầu có thể được hưởng lợi từ giải pháp hydrogen peroxide | Traumatic disorders of the nail 241 Complications of hyperkeratosis When the forces of pressure become overwhelming local haemorrhage or extravasation may appear in the hyperkeratotic tissue Figure Painful lateral hyperkeratosis from repeated microtrauma onychophosis. Figure Extravasated apical callus following debridement in a person with diabetes. giving a red-brown spotted appearance. This is a sign that ulceration is likely to ensue and therefore requires preventive measures Figure . A text atlas of nail disorders 242 Treatment of hyperkeratotic changes When hyperkeratotic changes around the nail give rise to symptoms immediate treatment involves conservative resection of the nail plate to expose the lesion. Hyperkeratosis can then be debrided by a scalpel. Stubborn sulcal callus may benefit from hydrogen peroxide solution applied to it prior to treatment. Where the overlying nail is thickened or deformed reduction of the nail by drilling may be required and nail edges should be filed well back Figure . Following resection packing the nail sulci lightly with cotton wool may reduce discomfort. Preventive measures include the regular application of urea-based emollients to the nail sulci to soften the surrounding skin. Footwear should also be assessed and appropriate advice should be given. Where possible overlapping toes or other causative digital Figure An electric nail drill with diamond burr. deformities may be accommodated and protected by the use of silicone appliances. Onycholysis and onychomadesis Excess friction between the nail and the shoe may result in onycholysis and even in fluid-filled blisters. These subungual bullae can sometimes be haemorrhagic Figure . Similar friction at the base of the nail may produce onychomadesis. Separation of the nail from the subungual tissue is often seen in ballet dancers who dance on points and in footballers. Subungual hyperkeratosis is usually associated with excessive pressure and .